APPLICATION FOR AMHERST COLLEGE
COMMUNITY COLLEGE TRANSFER OPEN HOUSE
Saturday, November 10, 2007
Thank you for your interest in attending the Amherst College Community College Transfer Open House. To be
considered for the program, you must submit a completed application and a copy of your college transcript.
The transcript does not need to be official. You may submit photocopies of your transcript.
Please mail your completed application to: Office of Admission, Amherst College, P.O. Box 5000, Amherst,
MA 01002-5000 or e-mail us at djreaume@amherst.edu. You may also fax the application at 413-542-2040.
Please attention all materials to Eduardo Garcia. The deadline for submission is Thursday, November 1st.
Personal Data
Name:
First
Sex (circle one):
Middle (complete)
Male
Female
Last/Family
Birth Date (month/day/year):
Mailing Address:
(number and street address)
(city and state)
Home Phone: (
(zip + 4 or postal code)
)
Area Code
Social Security Number (optional):
Number
E-mail Address*:
*Whenever possible, we will use email to send correspondence. Please provide us with a personal email address.
Print legibly and choose an email address that is checked REGULARLY and can receive emails from unknown
senders.
Citizenship (check one): □ U.S. If dual U.S. Citizen, please specify
□ U.S. Permanent Resident/ Citizen of
□ Foreign Citizen/ Citizen of
College Information
Name of College: ________________________________________________________________________________
College City and State: __________________________________Year of Graduation (Associates): ______________
Academic Areas of Interests: _______________________________________________________________________
Cumulative GPA: _______ on a _______ point scale
Academic Reference
Name: __________________________________________
Phone: (____)
_________________
Position (title): ____________________________________
E-mail: _____________________________________
Family Information (Please answer all questions. If parent has not graduated from college, please list highest level
of education. If information about a parent is unknown, please indicate why.)
Mother’s occupation:
College (if any):
Degree and Year:
Other Degrees:
________________________
________________________
________________________
________________________
Father’s occupation:
College (if any):
Degree and Year:
Other Degrees:
________________________
________________________
________________________
________________________
Financial Aid Information
Do you plan to be a Financial Aid Applicant to college?
□ Yes
□ No
Are you a recipient of financial aid at your current institution?
□ Yes
□ No
If under 24 years of age:
Approximate yearly family income (if applicable):
Mother: ____________
If you are currently working to support your education:
Employer: ____________________________________
□ Yes
Father: ______________
□ No
Position: ________________________________
Approximate yearly income: ______________________
Optional Information
First language, if other than English: _________________
Language spoken at home: ____________________
If you wish to be identified with a particular ethnic group, please check all that apply:
□ African American, Black, West Indian American
□ American Indian, Native American, Alaskan Native (tribal affiliation _______________ enrolled ________ )
□ Asian American (country of family’s origin __________________)
□ Mexican American, Puerto Rican, Hispanic, Latina/o (country of family’s origin ____________________ )
□ White or Caucasian American
□ Multiracial (please specify ____________________________)
□ Other (please specify ________________________________)
Additional Information
We are interested in learning more about you. In 150 words or less, please tell us a little bit more about yourself and your
goals for transferring to a four year institution.
*Please remember to submit your transcript with this completed application.